TW: eating disorders, discussion of BMI and ob*sity
Weight stigma isn’t only about the bullying, abuse and discrimination faced by fat people, it’s about wider societal systems of inequality and biases/assumptions which affect the way we think about eating disorders and disordered eating. Weight stigma and fatphobia is still present in eating disorder treatment and services, and is a barrier for so many people who need help.
Not all eating disorders develop from wanting to lose weight or dieting… BUT dieting is a big risk factor for developing an eating disorder. Weight stigma affects everyone, just in different ways and to different extents. Even if a person doesn’t have an eating disorder based on trying to lose weight, their access to treatment is based on a system embedded in fatphobia and weight stigma. And for those who do develop an eating disorder from trying to lose weight or diet, weight stigma was likely a huge catalyst in that.
The BMI chart
Eating disorder treatment is known to have very little funding and limited resources, meaning that many people end up being told they’re “not thin enough” for help (see Hope Virgo’s fantastic campaign “Dump the Scales”). The BMI (Body Mass Index) chart is relied upon far more than it’s meant to be, despite the NICE guidelines saying not to use BMI to diagnose an eating disorder or to make decisions about treatment. The DSM-5 – the big boss American diagnostic people – list the BMI categories specifically in terms of what is “too thin” so the entire system is based on conflicting messages. Ultimately, it seems that healthcare professionals are pushed into a place of using BMI to decide who gets treatment (in restrictive eating disorders, mainly anorexia) because there’s only enough space for the very sickest people to get help. What that means is they’re waiting for someone’s eating disorder to get so bad that there are risks of serious medical complications before they can get help. This is reactionary and generally just really, really unhelpful… to say the least.
The BMI scale was made in the 1830s by a mathematician and astronomer who based it on mainly European men – it was for general statistics, not a measure of individual health. So I think we can safely say that it isn’t exactly the best thing to be basing any kind of decisions/treatment on. When you add weight bias and eating disorder stereotypes (of people with anorexia being thin, white, young, female etc) this only makes the situation a whole lot worse.
We’ve all grown up in a world that tells us that thin equals beautiful, happy and successful, and health professions, GP’s therapists etc – as well as policymakers and people in charge – are not exempt from that. We hope that they’d address their own prejudices and biases during their training, and learn about eating disorders in the process, but this seemingly isn’t happening. I’ve heard too many stories of people who were told they couldn’t possibly have anorexia because they weren’t thin, and that somebody must binge eat because they’re fat. These kind of assumptions are due to weight biases and can be extremely harmful. In my experience as a trainee counsellor, we’ve barely talked about eating disorders on my training so far, so we certainly haven’t approached weight stigma (though I’ll be sure to find a way to bring in conversations about it of course!) GPs apparently only have a couple of hours of training on eating disorders, which is shocking. I’ve attended quite a lot of trainings/webinars/events about eating disorders and, no disrespect to any of them, but many of them were pretty basic. They just explain what the main eating disorders are, as if they’re rare diseases that are tragic flukes and completely out of our control. Yet eating disorders are deeply entwined with cultural and social ideas so we can all play a part in helping prevent them. This “othering” of eating disorders, seeing them as the opposite of ob*sity (they’re not) and disconnecting them from the normalised diet culture and fatphobic society we live in is not helping. Disordered eating is so normal in our society, many people likely can’t even tell if they have difficulties with food.
Bullying and shame
For people who have body image problems or eating issues due to trying to lose weight, many will have experienced bullying from a young age and may have encountered teachers, health professionals and other authority figures using shaming approaches to encourage weight loss. Kids can be mean, but they’re just exercising their power over people who seem different based on what they’re learning to be “normal” from their families, TV, films etc. When kids were mean to me at school I could try to shrug it off, but when adults and health professionals told me I had to lose weight, I had to do what I was told. It led to me trying to diet from a young age, trying to restrict my food, hating my body and blaming myself for being too fat. When it starts young, this stays with people for years and takes a long time to unpick. For me, it’s been many years of counselling, reading, learning and growing. It’s been 100% worth the effort though!
People can often be well-meaning with their comments about dieting or weight loss. Maybe they’re just saying what they think is expected of them, making a joke or genuinely trying to help people feel better about themselves. However, this just reinforces diet culture and the idea that “thin is good”. Attempting to change our bodies to make ourselves feel better or happier is only a surface-level, short-term solution. Instead of changing our bodies, it’s about changing the way we think about our bodies. That’s why body image and eating problems should all be part of a broader mental health conversation.
Eating disorders are often entwined with a fear of fatness (otherwise known as fatphobia). Many people working in eating disorders have a weight bias against fat people too – this isn’t to blame them as it’s something that is ingrained in our society. It’s systemic, throughout the medical profession and in our general culture, saturated in the system. So it’s nobody’s fault but it is our responsibility to recognise and challenge it in ourselves. Attempting to treat eating disorders in a system of fatphobia and weight stigma is hypocritical and counterproductive. Treatment within a broken system isn’t real treatment, it’s a Band-Aid at best.
We are told we have an “ob*sity epidemic” whilst we in fact have a huge mental health crisis going on, throughout an actual pandemic (COVID). All the ways our government has tried to help the “ob*sity crisis” so far have been based on shaming and stigmatizing approaches (mainly involving blaming individuals and making people feel like crap about themselves) and it’s causing more harm than good. The focus needs to be on mental health and relationships with food. I firmly believe that eating disorders are a much bigger issue than we see on the surface.
There are so many people who face barriers to treatment due to:
The list could go on. If we really knew the full scale of eating disorders, disordered eating and difficult relationships with food, we’d see the real epidemic.
What can we do
If you feel you’re struggling with any kind of body image or food-related problem, know that you can ask for help, even if you don’t think it’s serious or you don’t think it’s an eating disorder. Any kind of anxiety or distress around food or your body is important and you are deserving of help. For fat people especially – no body shape or size is more deserving of help, so go and take what you deserve!
For people who are not affected by eating or body issues, it’d be helpful if you’d spend some time considering your own relationship with your body and your views of others. This is very important if you work in medical care or are a counsellor/therapist (and especially fellow trainees – hello!) Learn about weight stigma and eating disorders, consider your own experiences growing up and the narratives you heard about thinness, fatness and eating. Think about the rules you had around food (eg at the dinner table) and the way fat people have been treated at school, in workplaces and in their everyday lives.
To everyone: consider shaking up your social media feeds – unfollow anyone who promotes dieting or thin ideals and follow diverse people instead. We need to hear more from people who are not the standard “norm” (mainly thin and white) to widen our views of the world and perceptions. As I hope I’ve demonstrated, the entire system is broken as it is based on fatphobia rooted in thin white bodies being the ideal. Anyone who doesn’t fit that (a LOT of people) is potentially be excluded, stigmatised and shamed. We must challenge the norms, the ideals and the stereotypes.
Thanks for reading. Here are some resources which might be helpful:
Anorexia & Bulimia Care
First Steps ED
Beating Eating Disorders
The National Centre for ED – excellent training for professionals
NEDA – I highly recommend the roundtable discussion videos from fat, LGBT+ and black communities
A note on the word ob*sity – many see this as stigmatizing language, hence the asterisk, as are terms like “ov*rwe*ght”, as they’re based on the BMI system which as explained is outdated, exclusionary and harmful to many people.
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